Sodium Intake and Incident Atrial Fibrillation in Individuals With Vascular Disease

Key Points Question Is estimated sodium intake associated with atrial fibrillation (AF) risk in individuals with vascular disease? Findings In this cohort study among 27 391 participants with vascular disease or high-risk diabetes enrolled in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and Telmisartan Randomised Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease trials, there was an independent J-shaped association between estimated sodium intake and atrial fibrillation incidence. Sodium intakes greater than 6 g/d were associated with 10% increase in risk for each additional 1 g of sodium consumed. Meaning These findings suggest that lowering sodium intake for AF prevention is best targeted at individuals who consume high sodium diets exceeding 6 g per day.

efigure 3 Cubic spline model for incident atrial fibrillation with additional covariate adjustment Adjusted for age, sex, randomization status in the ONTARGET/TRANSCEND trials, body mass index, systolic blood pressure, physical activity (moderate or strenuous physical activity habits vs sedentary), smoking (former or current smoker vs never smoker) and education (9-12 years or college/trade education or more vs 8 years or less), alcohol use, a history of diabetes, myocardial infarction, or stroke, systolic blood pressure, the use of beta-blockers, calcium channel blockers, aspirin, statins, and diuretics.Cox frailty models with a random effect on geographical region.Model 1 is adjusted for age, sex and randomization status in the ONTARGET/TRANSCEND trials.Model 2 is adjusted for Model1 + BMI, physical activity (moderate or strenuous physical activity habits vs sedentary), smoking (former or current smoker vs never smoker) and education (9-12 years or college/trade education or more vs 8 years or less) and alcohol use.Cox frailty model with a random effect on geographical region, adjusted for age, sex and randomization status in the ONTARGET/TRANSCEND trials, BMI, physical activity (moderate or strenuous physical activity habits vs sedentary), smoking (former or current smoker vs never smoker) and education (9-12 years or college/trade education or more vs 8 years or less) and alcohol use.
eAppendix.The Kawasaki method for estimating sodium intake We used the Kawasaki formula (1) to estimate24-h urinary excretion of sodium and potassium (in grams /d) from a fasting morning specimen.Previous studies (1,2) and our validation of the method in 11 countries, (3) showed that the estimated sodium excretion from the morning urine specimen shows a good correlation with direct measures of sodium excretion from the actual 24-h urine collection (intra-class correlation coefficient of 0.70;95% CI 0.61-0.77].The BP change per g of sodium was 2.11/0.78mm Hg,(4) which is consistent with the results of a meta-analysis of randomised controlled trials of sodium lowering in which sodium intake was measured using repeated 24 hour urine collections (5) efigure 4 a-c Cubic spline models for incident atrial fibrillation in individuals without (a) and with (b) diuretics, as well as individuals without hypertension using diuretics (c) a. Includes 19,774 individuals and 1,021 events b.Includes 7,617 individuals and 541 events c.Includes 1,012 individuals and 66 events

efigure 5 .
Cubic spline models for incident atrial fibrillation by estimated potassium intake Cox frailty model with a random effect on geographical region, adjusted for age, sex and randomization status in the ONTARGET/TRANSCEND trials, BMI, physical activity (moderate or strenuous physical activity habits vs sedentary), smoking (former or current smoker vs never smoker) and education (9-12 years or college/trade education or more vs 8 years or less) and alcohol use.sex-specific median (a) and randomly generated (b) Figure.Scatter plot of estimated versus measured 24-hour urinary sodium excretion.
(see summary Table below).Summary of validity, degree of bias, and reliability results for different methods of estimated 24-hour sodium excretion versus measured excretion (From Mente A, et al, 2014.J Hypertens 32:1005-14) (3).BP, blood pressure.† Significantly higher than 24-hour measured excretion.‡ Significantly lower than 24-hour measured excretion and Kawasaki estimated excretion.
© 2024 Johnson LS et al.JAMA Network Open.*Significantly greater bias than Kawasaki estimated excretion.